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1063915304 NPI number — LEANN NICOLE SMITH LPC

NPI Number: 1063915304
Health Care Provider/Practitioner: LEANN NICOLE SMITH LPC

Information about “1063915304” NPI (LEANN NICOLE SMITH LPC) exists in 1063915304 in HTML format HTML  |  1063915304 in plain Text format TXT  |  1063915304 in PDF (Portable Document Format) PDF  |  1063915304 in an XML format XML  formats.

NPI Number : 1063915304 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063915304",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SMITH",
    "FirstName": "LEANN",
    "MiddleName": "NICOLE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LPC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BASTIEN",
    "OtherFirstName": "LEANN",
    "OtherMiddleName": "NICOLE",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "LPC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4241 KALAMAZOO DRIVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CALEDONIA",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "49316-9606",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "616-730-1302",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4241 KALAMAZOO DRIVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CALEDONIA",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "49316-9606",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "616-730-1302",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/13/2018",
    "LastUpdateDate": "01/21/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "6401016474",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "6401224764",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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